Ketamine modulates the glutamate system via NMDA receptor antagonism, leading to increased BDNF production. This promotes neuroplasticity and enhances connectivity in brain networks involved in mood regulation. A 2019 study in The American Journal of Psychiatry demonstrated ketamine’s rapid antidepressant effects, often within hours, distinguishing it from slower-acting traditional psychiatric medications. These neurochemical changes help disrupt negative thought patterns, reduce anxiety, and facilitate emotional processing in PTSD, creating a window for meaningful therapeutic work.

Ketamine is thought to alleviate chronic neuropathic and centrally mediated pain by modulating the glutamate system, particularly through antagonism of N-methyl-D-aspartate (NMDA) receptors. This action reduces central sensitization, a key mechanism in chronic pain where the nervous system becomes hypersensitive to stimuli. Ketamine also influences descending pain inhibitory pathways and may reduce neuroinflammation. A 2018 meta-analysis in Pain Medicine found ketamine effective in reducing chronic pain intensity, with effects lasting up to two weeks post-treatment. Unlike traditional pain medications, ketamine’s rapid action and neuroplasticity-promoting effects, such as increased brain-derived neurotrophic factor (BDNF) production, help rewire pain-processing networks, offering relief for conditions like complex regional pain syndrome (CRPS), fibromyalgia, chronic migraine, and neuropathic pain.

Ketamine is FDA-approved as a general anesthetic. Its use at lower, subanesthetic doses for chronic pain, depression, anxiety, or PTSD is considered “off-label,” meaning it is not FDA-approved for these specific indications. Off-label prescribing is common; a 2014 study in Pharmacotherapy noted that approximately 33% of antidepressant prescriptions in primary care are off-label. For chronic pain, off-label ketamine use is supported by clinical guidelines, such as those from the American Society of Regional Anesthesia and Pain Medicine, which endorse ketamine for certain refractory pain conditions.

For mental health conditions, psychotherapy is essential for lasting benefits. Ketamine’s rapid relief from symptoms like depression or anxiety creates a window of increased openness and reduced negative thought patterns, enhancing psychotherapy’s effectiveness. A 2020 review in Frontiers in Psychiatry highlights that combining ketamine with psychotherapy maximizes long-term outcomes. Patients pursuing mental health treatment are required to work regularly with a psychotherapist.

For chronic pain, ongoing collaboration with a pain management specialist, neurologist, or primary care provider is strongly recommended to address underlying pain mechanisms and integrate ketamine into a comprehensive pain management plan. While not mandatory, this collaboration optimizes outcomes, as supported by a 2021 study in Regional Anesthesia & Pain Medicine, which emphasizes multidisciplinary care in ketamine therapy for pain. Patients must have an established provider to continue managing other pain or psychiatric medications.

No, we do not mandate a specific psychotherapist or pain specialist. For mental health patients, the key is regular, meaningful therapy with a provider you trust and with whom you feel safe. For chronic pain patients, you should work with a provider experienced in pain management who can coordinate care. It’s ideal to have an established relationship with these providers before starting ketamine therapy to ensure continuity of care.

Ketamine induces a non-ordinary state of consciousness, often described as a sense of timelessness, ego dissolution, profound emotional or revelatory experiences, or an out-of-body sensation. Sensory alterations, such as changes in perception of sound or visuals, are also common. For pain patients, some report a temporary reduction in pain perception during the session. These experiences typically last 45–75 minutes. A 2022 study in Journal of Affective Disorders on at-home ketamine noted that dissociative effects are generally well-tolerated and subside shortly after administration.

Ketamine is not a “miracle drug” requiring only a few sessions, despite media portrayals. Both chronic pain and mental health patients benefit from a phased approach:

1. Dose-Finding Phase: We identify the optimal subanesthetic dose that effectively reduces symptoms, typically over 1–3 weeks.

2. Stabilization Phase: Patients maintain the target dose for 6–8 weeks, with mental health patients engaging in weekly psychotherapy and pain patients coordinating with their specialists. This phase leverages ketamine’s neuroplasticity to reinforce positive changes in mood or pain processing, as supported by a 2023 study in Neuroscience & Biobehavioral Reviews.

3. Weaning Phase: Ketamine is gradually reduced while monitoring for symptom recurrence. If symptoms worsen, patients may return to the stabilization phase with adjusted therapy or specialist input.

Ketamine is not intended for long-term maintenance, and Slopeside Vitality does not prescribe it as such.

For mental health, a 2017 meta-analysis in Neuropsychopharmacology found ketamine effective in reducing depressive symptoms in up to 70% of patients.

For chronic pain, studies show ketamine reduces pain by at least 50% in 50–70% of patients with neuropathic or centrally mediated pain, per a 2020 review in Current Pain and Headache Reports.

Response rates vary, and a small subset of patients may not respond. Results are not guaranteed.

Ketamine is contraindicated in individuals with:

• Uncontrolled hypertension or hyperthyroidism

• Schizophrenia, psychosis, or bipolar disorder with active mania/hypomania

• Elevated intracranial pressure or uncontrolled glaucoma

• Recent stroke, heart attack, or certain cardiovascular conditions

A detailed medical history review by Dr. Sebesto determines eligibility. Medical clearance from a primary care provider or specialist may be required.

When administered as directed in a medically supervised setting, ketamine shows no evidence of addiction, per a 2021 review in The American Journal of Drug and Alcohol Abuse. In fact, ketamine is being studied for treating substance use disorders due to its potential to reduce cravings.

Common side effects include nausea, blurred vision, balance difficulties, sedation, fatigue, and temporary cognitive changes. These typically resolve within hours post-session. A 2022 study in Journal of Clinical Psychiatry involving 1,247 at-home ketamine patients reported a low dropout rate (0.3%) due to non-life-threatening side effects, with no life-threatening events. Rare risks, such as bladder irritation with prolonged use, will be discussed during consultation.

A 2022 study by researchers from NYU, UCSF, Cleveland Clinic and Houston Methodist involving 1247 patients taking at-home ketamine for anxiety and/or depression not only demonstrated the clinical benefit of at-home ketamine, but found at-home ketamine to be quite safe with only 4 participants (0.3% of participants) leaving the study due to non-life-threatening side effects. No study participants experienced any life-threatening side effects.

Ketamine is provided as lozenges, rapid-dissolving tablets, nasal sprays, or suppositories, tailored to patient needs. Dr. Sebesto does not manage other medications but will coordinate with your prescribers. At-home ketamine is not covered by insurance for pain or mental health treatment, and Slopeside Vitality does not accept insurance. A full consultation will cover administration protocols, safety measures, and costs.

Dr. Sebesto does not manage other medications including conventional psychiatric medications. However, he is available to coordinate care with your other prescribers.

We do not take insurance, as at-home ketamine is not covered for the purposes of treating depression, anxiety, PTSD and chronic pain.

At Slopeside Vitality, we prioritize personalized care and affordability. As a client, you’ll have direct access to your physician, who will take the time to build a genuine relationship with you—not just treat you as another appointment. When you contact our clinic, your physician responds directly, without intermediaries like answering services or receptionists.

While our monthly fee may seem substantial, it’s significantly more affordable than many leading nationwide clinics, which often charge $1,000 or more for just 4–6 dosing sessions. At Slopeside Vitality, you receive unparalleled personal attention and availability at a fraction of the cost.